住院期间血浆BNP水平动态变化对急性STEMI患者出院后发生CHF的预测价值  

Predictive value of dynamic change of plasma BNP level during hospitalization for CHF in acute STEMI patients after discharge

作　　者：程澜 付倩雨[1] 周龙华 范宇琴 刘芬芬 樊院院 张欣 林伟青[1] 吴小和[1] CHENG Lan;FU Qian-yu;ZHOU Long-hua;FAN Yu-qin;LIU Fen-fen;FAN Yuan-yuan;ZHANG Xin;LIN Wei-qing;WU Xiao-he(Department of Geriatric,People's Hospital of Jiangxi Province,Nanchang,Jiangxi,330006,China)

机构地区：[1]江西省人民医院老年科,江西南昌330006

出　　处：《心血管康复医学杂志》2021年第5期540-544,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:研究住院期间血浆BNP水平动态变化对急性STEMI患者出院后发生CHF风险的预测价值。方法:根据发病24h到第5d内血浆BNP水平变化值,我院的236例急性STEMI患者被分为BNP动态变化组(116例,血浆BNP水平变化>82pg/dl)和BNP无动态变化组(120例,血浆BNP水平变化≤82pg/dl)。比较两组一般临床资料,随访1年,评定两组Kaplan-Meier生存曲线及全球急性冠状动脉事件注册(GRACE)评分,分析血浆BNP水平动态变化及上述两项联合检测对CHF的预测价值。结果:与BNP无动态变化组比较,BNP动态变化组甘油三酯水平[(137.0±59.0)mg/dl比(180.0±74.0)mg/dl]显著升高,发病后第5d血浆BNP水平[342.0(274.0,434.8)pg/dl比120(98.0,155.0)pg/dl]显著降低,P<0.05或<0.01。Kaplan-Meier生存曲线分析显示,BNP动态变化组随访1年内CHF发生风险显著高于BNP无动态变化组(P=0.017)。ROC曲线分析显示,GRACE评分、血浆BNP水平动态变化及二者联合检测预测CHF的敏感度分别为72.1%、67.6%、82.4%,特异性分别为64.9%、91.7%、69.0%,曲线下面积分别为0.705、0.820、0.847;血浆BNP水平、两项联合检测对CHF的预测价值均显著高于GRACE评分(P=0.043,0.001)。结论:住院期间血浆BNP水平动态变化联合GRACE评分对急性STEMI患者出院后1年内发生CHF具有一定预测价值。Objective:To study predictive value of dynamic change of plasma BNP level during hospitalization for CHF risk in acute STEMI patients after discharge.Methods:According to change value of plasma BNP level from 24h to 5th day after onset,a total of 236 acute STEMI patients treated in our hospital were divided into BNP dynamic change group(n=116,plasma BNP level change>82pg/dl)and no BNP dynamic change group(n=120,plasma BNP level change≤82pg/dl).General clinical data were compared between two groups.Kaplan-Meier survival curve and predictive value of GRACE score,dynamic change of plasma BNP level and above stated dual detection for CHF after one-year follow-up were analyzed.Results:Compared with no BNP dynamic change group,there were significant rise in triglyceride level[(137.0±59.0)mg/dl vs.(180.0±74.0)mg/dl],and significant reduction in plasma BNP level on 5th day after onset[342.0(274.0,434.8)pg/dl vs.120(98.0,155.0)pg/dl]in BNP dynamic change group,P<0.05 or<0.01.Kaplan-Meier survival curve analysis indicated that within one-year follow-up,CHF risk of BNP dynamic change group was significantly higher than that of no BNP dynamic change group(P=0.017).ROC curve analysis indicated that sensitivity of GRACE score,dynamic change of plasma BNP level and dual detection predicting CHF was 72.1%,67.6%and 82.4%respectively,specificity was 64.9%,91.7%,and 69.0%respectively,AUC were 0.705,0.820 and 0.847 respectively;predictive value of plasma BNP level and dual detection for CHF were significantly higher than that of GRACE score(P=0.043,0.001).Conclusion:Dynamic change of plasma BNP level during hospitalization combined GRACE score possesses certain predictive value for CHF in acute STEMI patients within one year after discharge.

关 键 词：心肌梗死 心力衰竭 利钠肽 脑 

分 类 号：R542.22[医药卫生—心血管疾病]